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How changing our healthcare system impacts science: my experience as a postdoc looking for insurance

In 2005, I heard that I had received a National Science Foundation (NSF) postdoc to go work at the University of Wisconsin. I was thrilled about the opportunity, and really looked forward to starting. But, as I worked on the logistics of moving, I discovered a major hurdle: because the National Science Foundation would pay my stipend directly to me, the University of Wisconsin didn’t consider me an employee, even though NSF was also sending them an institutional allowance in exchange for hosting me. The biggest impact of this was that I was not eligible for health insurance through the University of Wisconsin. Instead, I had to try to purchase health insurance as an individual. At first, I was denied coverage.

Based on conversations I’ve had over the years and replies to some tweets I wrote, there are a lot of people who have found themselves in similar situations. In this post, I’ll talk about my experience more and talk about some of the ways this might impact science.

When I first learned I would need to apply for insurance on my own, I didn’t think it would necessarily be a big deal. I thought of myself as being pretty healthy. Sure, I had allergies and asthma, but they were well controlled. So, I applied for insurance and didn’t really worry about it. Then I heard I was denied coverage because I had pre-existing conditions (allergies and asthma).

Prior to the Affordable Care Act (popularly known as Obamacare), insurance underwriters would evaluate applicants to determine how risky they seemed and how much coverage to offer. It meant that some people were unable to find coverage at all, while others had to settle for policies that cost more and covered less.

I ended up being relatively fortunate. Based on the way the Michigan State student health insurance worked, it automatically covered me for the first several months of my postdoc. (I think it covered me through August – that is, my first 6 months – but it’s possible my memory is off on the exact details.) I was then able to extend my student insurance (through COBRA) for longer – again, I can’t remember the exact dates, but I think it was 6-12 months. That bought me time, and, during that time, I was able to shop around and find a plan that would cover me partially. It didn’t cover anything related to allergies and asthma, and it didn’t include maternity coverage, but it did cover everything else.

Wisconsin is far from alone in saying people with NSF postdocs are not employees. This happens at many (but not all) universities and is a major sticking point. I know people who have turned down these postdocs – even though they are really prestigious and otherwise a pretty amazing support package – because they would be unable to get health care on the private market. Think about how this impacts access to prestigious research opportunities: women and people with disabilities are disproportionately impacted when they need to purchase health insurance on the private market.

Since I had time to plan, I started a process where I would fill my prescriptions religiously every month but then only take the medicine two days out of three (or every other day if I could get away with it) so that I would still have the medicines I needed when I was off my student health insurance. This lack of access to medicines (which made it so that I was a much more effective scientist!) was a major problem under the old healthcare system. Sarah Hörst had a tweetstorm about how students in her grad program dealt with not having prescription drug coverage before the Affordable Care Act. The short version is that her father helped grad students get samples from drug reps. That was the only way they could access the medicines they needed.

And, even though I was initially denied healthcare and then ended up on a plan that was not comprehensive, I still consider myself lucky. I was only able to extend my student health insurance because the MSU grad students had recently unionized. Before that, the only health care available to students was in (or very near) East Lansing, which would not have been useful to me in Madison, Wisconsin. I was able to use COBRA to extend my student insurance, which isn’t true everywhere. I had time to plan for a gap in prescription coverage. While I was on the individual plan, I never had an emergency: a trip to the ER for any problem that could have been related to asthma or allergies would not have been covered. I didn’t get pregnant.

I was also lucky in another way: as a postdoc, I didn’t yet have a diagnosis for anxiety and hadn’t yet had a cesarean section. But with a slightly different life path, those would have been in my medical record when I was applying. And, if they had been, it’s likely that I wouldn’t have been able to find a health insurance plan at all.

This impacts science. If people are not receiving the healthcare they need (because they lack insurance or fear that receiving care will impact their ability to get insurance in the future), they will not be as effective as scientists. And if they need to purchase health insurance as an individual, it cuts off opportunities to some people, and those people are disproportionately women and people with disabilities. I know people who are likely to move to postdocs in the next year or two who are very worried about whether they would be able to find health insurance if this new law passes.

And, while the inability to purchase comprehensive, affordable health insurance while on certain fellowships is a problem, it is far from the only way scientists – and, therefore, science – will be impacted. To list just a few: People who work as adjuncts or short-term technicians will once again find it much harder to access health care. As Susan Perkins noted on twitter, people who are being harassed or bullied at work will feel unable to move. And even employer provided health care policies might be impacted.

So far, the bill has just passed the House of Representatives. That means there is still time for the bill to change. But, as it stands, this bill will impact science and restrict who gets to do science. I hope that won’t come to pass.

I forgot to put in the post that my official university title while I was a postdoc was “Honorary Fellow”. That seemed unsatisfying until I realized it was the same title as Bobbi Peckarsky. Then it seemed pretty cool. 🙂

Very nice reflection. This is a parallel issue, but I’d like to comment on the general situation of postdocs. Postdocs are usually in very unstable, unsafe situations in many universities and countries. They are neither faculty nor students, and so work in a limbo, especially if they receive scholarships and are not formally hired. This makes everything more difficult, from hiring medicare to paying special prices in university restaurants or living in official flats. Despite a postdoc being the nicest stage of the career (in my opinion), it can be stressful due to this insecurity.

Yes, I completely agree. To add another difficult: it also makes parental leave challenging. We essentially force people to move frequently during prime reproductive years, but then penalize them for not having been at a place long enough. (Often benefits don’t fully kick in until 6 months or a year have passed.) I’ve been raising this issue related to benefits here at Michigan. The solution would be to require everyone to pay somewhat higher fringe to extend benefits to all postdocs from as soon as they start (which is how it works for faculty). I haven’t seen the numbers yet, so don’t know how hard a sell it will be.

Yes, you are absolutely right. I had my son during my PhD, spent 6 years as a postdoc, and know from experience that building an academic career with a family is quite challenging. I hope your solution at Michigan works. Here at UFMG, what I have been trying to do to improve life for postdocs is implementing regulations about their rights and duties (yes, we are several steps behind…).

I was in a very similar situation but with an NIH fellowship. And I had two kids, one 2.5 years old and the other 6 months old when I found out. I had to use the full “extra” portion of the NIH fellowship (the part some folks would use for travel to conferences, research, etc) to cover some of my health insurance and thankfully, my PI agreed to cover the rest of the costs since the fact that my fellowship covered my stipend meant she was still saving money (compared to paying me on her start-up finds and thus granting me university employee status). I would have been forced to turn down the fellowship otherwise.

This is very scary to me. I have a major disability which is only kept in check by taking a lot of daily medication. I’m thinking of applying for a post-doc at Purdue and am really worried about what the health insurance market will look like there, especially as I am considering applying for an NSF post-doc.

Why waste time writing an article if you’re only going to write an opinionated piece that serves only one purpose and that purpose is to be a political puppet. Perhaps, it’s our duty, as humans, to be responsible for one’s self? The government was never intended to do that for us.

This blog used to be phenomenal and very informative. It used to be filled with interesting conversations about ecology and science but lately it’s become a political sideshow with an agenda.

Get back on track, get back to intellectual conversations about ecology!

Thank you for your feedback, even if I don’t appreciate the tone in which you provided it. If you really found our blog so phenomenal and informative, one would think you’d be able to phrase a request for more ecology-focused posts a bit more politely.

Meghan, Brian, and I write whatever we feel moved to write about, trusting readers to pick and choose as they wish. Which most readers do; few readers read all our posts. Different readers like different sorts of posts (see https://dynamicecology.wordpress.com/2014/11/25/reader-survey-results-2/). It would be impossible for Meghan, Brian, and I to please everyone even if we tried.

“Perhaps, it’s our duty, as humans, to be responsible for one’s self?”

Perhaps one way for humans to responsible for themselves is to organize themselves into societies run by mutually-beneficial institutions.

And since you consider it a duty to take responsibility for yourself, perhaps you should consider taking more responsibility for choosing your own reading material. There are some ecology-specific posts in the queue; keep an eye out for them.

I’m also not sure how having a pre-existing condition is a lack of personal responsibility. What, exactly, did I do wrong to have preexisting conditions that made it so that I was denied health insurance? One person who commented on twitter on Friday noted that her career path was influenced by where she would be able to get an insulin pump. Why should science lose out on the ideas and talents of people who would be unable to pursue such opportunities because they happen to have type I diabetes?

Great post Meghan! I am currently a post-doc in New Zealand. Not only do I get a fair salary but public health care (and a tax rate only ~5% greater than federal taxes in the US). I can’t imagine being a scientist and not working towards social justice. I spend much of my day looking at how bacterial communities organize themselves, why would I not look outwards at my own community and work towards a better way of organizing a civil society?

Why waste time leaving a comment if you’re only going to write an opinionated one that serves only one purpose and that purpose is to be an extreme asshole?

These comments used to be phenomenal and very informative. They used to be filled with interesting conversations about ecology, science, and life in science but lately they have become a political sideshow with an agenda.

Get back on track, get back to intellectual comments about life as an ecologist, and the difficulties one faces when negotiating various aspects of getting paid to do your job!

I am a mere geologist, and its true that we geos are lower life forms. Nonetheless, I’m certain that – technically – I *host* a bacterial bacterial community, which may or not be highly organized and/or efficient, but is certainly not always well behaved. Yesterday, I shamelessly used collective punishment, dousing the entire horde with Genuine A&W Root beer to quell an insurrection.

I don’t know if it’s the same at all universities, but at least at some, it isn’t just NSF postdocs who don’t count as university employees. NSF graduate fellows don’t count either. You can still get student health insurance, but you have to pay full costs.

Not providing health care to NSF GRFs is really terrible. That is entirely at the discretion of the school. The “cost of education (COE) allowance” (I.e. the 12,000 USD the university receives per fellow to cover tuition and fees) can be used to cover health insurance if the school chooses it to.

Quite frankly, there is an easy fix to this. The NSF requires the schools to provide fellows with health insurance. Schools already cannot charge students extra tuition over the $12,000 the school already receives (even if tuition at that school is over 12k). I don’t see how health insurance is really any different. Schools benefit so much from GRFs. The least they can do is provide them with health insurance (the same for postdocs).

I completely agree that this problem extends to pre-doc fellowships as well. I have a student with a NASA grad fellowship and for whatever accounting reason, she can’t be paid as a regular RA and is therefore ineligible for health insurance and other benefits that our graduate student union negotiates. Luckily she has been able to sign up for COBRA coverage because she was previously appointed as an RA, but it has added about 50 new hoops to jump through. Pretty frustrating that some universities make life harder for these successful students & postdocs.

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